title: Predicting outcome after cardiopulmonary arrest in therapeutic hypothermia patients: clinical, electrophysiological and imaging prognosticators.
abstract: BACKGROUND
  Predicting outcome in comatose survivors of cardiac arrest is based on data validated by guidelines that were established before the era of therapeutic hypothermia. We sought to evaluate the predictive value of clinical, electrophysiological and imaging data on patients submitted to therapeutic hypothermia.
  
  
  METHODS
  A retrospective analysis of consecutive patients receiving therapeutic hypothermia during years 2010 and 2011 was made. Neurological examination, somatosensory evoked potentials, auditory evoked potentials, electroencephalography and brain magnetic resonance imaging were obtained during the first 72 hours. Glasgow Outcome Scale at 6 months, dichotomized into bad outcome (grades 1 and 2) and good outcome (grades 3, 4 and 5), was defined as the primary outcome.
  
  
  RESULTS
  A total of 26 patients were studied. Absent pupillary light reflex, absent corneal and oculocephalic reflexes, absent N20 responses on evoked potentials and myoclonic status epilepticus showed no false-positives in predicting bad outcome. A malignant electroencephalographic pattern was also associated with a bad outcome (p = 0.05), with no false-positives. Two patients with a good outcome showed motor responses no better than extension (false-positive rate of 25%, p = 0.008) within 72 hours, both of them requiring prolonged sedation. Imaging findings of brain ischemia did not correlate with outcome.
  
  
  CONCLUSIONS
  Absent pupillary, corneal and oculocephalic reflexes, absent N20 responses and a malignant electroencephalographic pattern all remain accurate predictors of poor outcome in cardiac arrest patients submitted to therapeutic hypothermia.
  
  
  CONCLUSIONS
  Prolonged sedation beyond the hypothermia period may confound prediction strength of motor responses.
authors.affiliation: Unidade Cerebrovascular, Centro Hospitalar de Lisboa Central, Lisboa, Portugal. brunocruzmaia@gmail.com
authors.forename: Bruno
authors.initials: B
authors.lastname: Maia
authors.forename: Rafael
authors.initials: R
authors.lastname: Roque
authors.forename: Alexandre
authors.initials: A
authors.lastname: Amaral-Silva
authors.forename: Sónia
authors.initials: S
authors.lastname: Lourenço
authors.forename: Luís
authors.initials: L
authors.lastname: Bento
authors.forename: João
authors.initials: J
authors.lastname: Alcântara
mesh_terms: D000328:Adult; D004569:Electroencephalography; D005071:Evoked Potentials; D005189:False Positive Reactions; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies